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· The routine use of ultrasound is not indicated to diagnose a scaphoid fracture. Low-frequency ultrasound has not proven to be of any advantage, whereas high-frequency ultrasound can be helpful in the diagnosis of a scaphoid fracture. The interpretation of ultrasound is again dependant on the level of experience of the clinician.
Is ultrasound reliable in the diagnosis of scaphoid fractures?
· It is normally not used if the injury is associated with an underlying fracture because of the pain that is produced, but in this study ultrasound has been used to diagnose scaphoid fractures before reliable radiographic evidence is available. We also used ultrasound to assess the progress of healing to modify the overall supervision.
What is the best treatment for a scaphoid fracture?
The hallmark symptom of a scaphoid fracture is known as “snuffbox” tenderness. The snuffbox, also known as the radial fossa, is located by making a thumbs up sign. The depression in the skin that occurs at the wrist below the thumb is the snuffbox. A scaphoid fracture will result in pain, tenderness, swelling, and bruising centered around ...
What does it mean when a scaphoid fracture is not healing?
The goals of treatment for scaphoid nonunions and malunions are to achieve healing and to correct of any carpal deformities to prevent arthritis of the wrist. 29 Nonoperative treatments of scaphoid nonunions include electrical or ultrasound …
Are vascularized bone grafts the best treatment for scaphoid fractures and nonunions?
In cases of suspected scaphoid fracture where the initial radiographs are negative, a supplementary MRI, or alternatively CT, should be carried out within three to five days.Fracture classification, assessment of dislocation as well as evaluation of fracture healing is best done on CT with reconstructions in the coronal and sagittal planes, following the longitudinal axis of the …
Does ultrasound promote bone healing?
Ultrasound for Bone Healing There is some scientific evidence showing that certain fractures, specifically fresh fractures, can show faster healing with the use of ultrasound.
What is the best treatment for a scaphoid fracture?
The most intense fractures require surgery. Your surgeon will realign (set) your scaphoid to its correct position and then secure it in place so it can heal and grow back together.
How do you speed up the scaphoid fracture healing?
The Road to RecoveryImmobilizing the area until your physician says it is okay to reintroduce movements and strengthening exercises.Using a cast or brace to help reinforce your efforts at immobilizing the scaphoid bone.Quitting smoking as this habit can delay any kind of healing by the body.More items...•
Is ultrasound contraindicated with fracture?
Historically, the ultrasound has been contraindicated in the setting of fractures. This is largely due to early animal studies, showing that ultrasound treatment delayed or even damaged the healing bone.
What happens if scaphoid doesnt heal?
If a Scaphoid fracture does not heal, it is called a Scaphoid Fracture Non-union. If left untreated, the part of the Scaphoid that interacts with the Radius may die, which can lead to painful arthritis in the wrist, developing months to years after the initial injury.
Can you move your wrist with a scaphoid fracture?
A scaphoid fracture that is correctly treated soon after the injury will take about 12 weeks to heel. But an untreated fracture may take as long as six months to recover from. Untreated patients will also usually experience long-term problems moving their wrist or other complications (see below).
Will my scaphoid ever heal?
Conclusion Subacute scaphoid fractures (presenting within 6 months from injury) can be expected to successfully heal with casting alone, even if the initial diagnosis is delayed.
Can you move your thumb with a scaphoid fracture?
Most people with a scaphoid fracture (which is the same as a broken wrist) will have pain and/or swelling along the thumb side of the wrist within days following a fall. Because there is no visible deformity and no difficulty with motion, many people with this injury assume that it is a wrist sprain.
Can a scaphoid fracture heal without surgery?
Yes. If you receive proper treatment and restrict activity with your hand, a scaphoid fracture may heal without surgery. Your doctor will likely recommend casting if it appears that the bones may heal on their own. The cast immobilizes your wrist, so the pieces of bone to fuse back together.
What are the side effects of ultrasound therapy?
Therapeutic ultrasound has no known harmful effects when done right by your therapist. The therapy will help alleviate body pain in the affected areas. Ultrasound physical therapy is noninvasive; hence, it's safer than other methods.
Can ultrasound damage bones?
Low-intensity pulsed ultrasound (LIPUS) has been proposed as a method for promoting fracture healing. Historically, ultrasound was contraindicated in the setting of fractures. Much of this arose from animal data demonstrating that ultrasound damaged bones or delayed fracture healing.
Does ultrasound help inflammation?
Ultrasound (US) therapy is used to reduce pain and inflammation and to accelerate healing after soft tissue injury.
What happens if you leave a scaphoid fracture untreated?
If the condition is left untreated for too long, then the blood supply to the scaphoid bone can be compromised, which can cause the bone to die, and this leads to complications and pain and loss of motion and use in the wrist, which can have devastating effects. How long does it take for a scaphoid fracture to heal?
What causes a scaphoid fracture?
Scaphoid fractures are caused by a fall onto an outstretched hand where the force is concentrated on the thumb, or radial side of the hand. These forces can also be replicated in an athletic injury or due to trauma sustained in an automobile accident.
How to speed up bone healing?
Splinting and electrostimulation can aid in speeding up the healing process if the bloodflow to the bone is steady. Surgery may be necessary in more severe cases.
Is scaphoid bone a delicate bone?
The scaphoid is a delicate bone with a precarious blood flow, so home treatment without the aid of a medical professional is not recommended.
How long does it take for a thumb fracture to heal?
The wrist and thumb are immobilized in a short arm thumb spica cast until the fracture is healed. Some surgeons may treat this in a cast above the elbow for the first 6 weeks followed by a short cast. If, however, after 6 weeks of casting the fracture is not healing properly, a bone stimulator may be used.
How long does it take for a scaphoid fracture to show up on a plain film?
It may take up to two weeks for a fracture line to show up on plain films, especially if the fracture is non-displaced. For this reason, anyone who has snuffbox tenderness should be assumed to have a scaphoid fracture until proven otherwise.
Can a scaphoid fracture be seen on X-rays?
Oftentimes, the patient who has sustained a scaphoid fracture attempts to self-treat at home with rest and ice, and presents for evaluation days later because the symptoms have not improved. For those who are evaluated at the time of injury, X rays taken in the emergency department may not show a scaphoid fracture.
What is the best way to diagnose a scaphoid fracture?
If a scaphoid fracture is identified on the radiographs and appeared nondisplaced, then a CT scan is performed to evaluate fracture displacement. If the radiographs are negative or equivocal, MRI is performed to determine the presence or absence of a scaphoid fracture and to identify other possible causes of the wrist pain. In cases of scaphoid nonunion, preoperative MRI is recommended to assess vascularity of the proximal pole. It is, however, important to recognize that standard MRI shows only 68% accuracy for assessing proximal pole vascularity, while gadolinium enhanced MRI has 83% accuracy.18
How to tell if a scaphoid fracture is a scaphoid fracture
Tenderness in the anatomic snuff box or scaphoid tubercle may suggest a scaphoid fracture. If there is a scaphoid fracture, the wrist’s range of motion is slightly restricted and thumb movement may be painful. Reduced grip strength may be noted. It is important to recognize that not all patients have pain over the scaphoid, even if a well-defined fracture is seen on radiographs. Overall, the diagnostic sensitivity (true positive rate) is high for clinical examination, but specificity (true negative rate) approaches only to 74% to 80%.8,9
Why is internal fixation indicated for displaced waist and proximal pole scaphoid fractures
Internal fixation is indicated for displaced waist and proximal pole scaphoid fractures because they have a high risk of delayed union, nonunion, or AVN. An unstable scaphoid fracture is defined as a displacement of the fractured fragments by more than 1 mm in any view. Fractures progressively displaced during cast immobilization are also considered as unstable fractures, even if there is no initial displacement. Proximal pole fractures are more likely to progress to nonunion or AVN because of the tenuous blood supply to the proximal pole of the scaphoid; therefore, internal fixation is strongly recommended.
Is percutaneous fixation more challenging than open fixation?
Concerning the fixation techniques, the percutaneous technique is more challenging than the open technique but it has the advantages in that the carpal ligaments are not divided (thereby preserving the ligament support of the wrist), the blood supply to the scaphoid is not interrupted and there is less scarring that can limit wrist motion. Therefore, percutaneous fixation performed by experienced surgeons may be recommended for active patients with a nondisplaced or minimally-displaced scaphoid fracture.
What should be included in a wrist radiograph?
Initial wrist radiographs should include standard posteroanterior (PA), lateral, 45° pronated oblique, and 45° supinated oblique views, as well as a PA view in ulnar deviation (scaphoid view).10The scaphoid view may visualize the fracture because the ulnar deviation of the wrist distracts unstable fracture fragments. The sensitivity (true positive rate) of plain radiographs is approximately 70% for scaphoid fractures.11If there is a high clinical suspicion of a scaphoid fracture but with no radiographic evidence, a short arm thumb spica cast is usually applied.12Follow-up radiographs may show bone resorption or early callus formation adjacent to the fracture site, if an occult fracture did indeed exist. However, this traditional treatment with repeat radiographs and immobilization can lead to a loss of work and has economic implications. It has been reported that 75% to 80% of patients who had clinical suspicion of scaphoid fractures would be immobilized unnecessarily if they underwent traditional treatment.13Recently, early definitive evaluation with bone scintigraphy, magnetic resonance imaging (MRI), or computed tomography (CT) has been advocated by many authorities as means of detecting occult scaphoid fractures. Bone scintigraphy has demonstrated 92% to 95% sensitivity and 60% to 95% specificity for scaphoid fractures.14On the other hand, MRI has shown 95% to 100% sensitivity and specificity for scaphoid fractures.15MRI may be superior to bone scintigraphy due to fewer false-positive results and the ability to identify other causes of wrist pain, such as ligamentous injury, which can not be diagnosed with bone scintigraphy. Drawbacks of MRI are that it is not readily available in most treating centers, it is relatively expensive, and it may not clarify any fracture displacement. CT scans are less costly, more readily available, and give a clearer visualization of fracture displacement than MRI. However, CT scans should be used with caution for triage of nondisplaced scaphoid fractures because false-positive results may frequently occur, perhaps due to misinterpretation of vascular foraminae or other normal lines in the scaphoid. CT scans are therefore useful for ruling out displacements, but not for diagnosing them. If the amount of displacement cannot be ascertained accurately with plain radiograph and whether to recommend surgery relies on this piece of critical information, then having the CT images will be quite helpful in guiding treatment. The amount of displacement by plain radiograph was noted to poorly correlate with the operative findings.17
What is the most common carpal fracture?
The scaphoid is the most commonly fractured carpal bone, accounting for approximately 60% of all carpal fractures.1The importance of a correct diagnosis and appropriate treatment of scaphoid fractures lies in its blood supply. The main blood supply to the scaphoid is from the radial artery. Over 80% of the scaphoid surface is covered with articular cartilage. The dorsal scaphoid branches from the radial artery enter the nonarticular portion of the scaphoid at the dorsal ridge at the level of the waist and supply the proximal 70% to 80% of the scaphoid.2The volar scaphoid branches from either the radial artery or the superficial palmar branch enter at the distal tubercle and supply the distal 20% to 30% of the scaphoid. Thus, the vascularity of the proximal pole depends entirely on intraosseous blood flow. This tenuous blood supply to the proximal pole of the scaphoid helps to explain the increased frequency of delayed union, nonunion and avascular necrosis (AVN) of scaphoid fractures. AVN is reported to occur in 13% to 50% of scaphoid fractures, with an even higher incidence in those involving the proximal one-fifth of the scaphoid.3,4
Can a scaphoid fracture be treated?
Improvements in the diagnosis, surgical treatment and implant materials have encouraged a trend towards early internal fixation, even for nondisplaced scaphoid fractures that could potentially be treated nonoperatively. Despite the advent of newly developed fixation techniques, including open and percutaneous fixation, the nonunion rate for scaphoid fractures remains as high as 10% after surgical treatment. Scaphoid nonunions can present with or without avascular necrosis of the proximal pole, and may show a humpback deformity on the radiograph. If left untreated, scaphoid nonunions can progress to carpal collapse and degenerative arthritis. Surgical treatment is directed at correcting the deformity with open reduction and internal fixation with bone grafting. Recently, vascularized bone grafts have gained popularity in the treatment of scaphoid nonunions, particularly in cases with avascular necrosis. This article reviews current concepts regarding the treatment of scaphoid fractures and nonunions.
What are the challenges of scaphoid fractures?
Scaphoid fractures are common but present unique challenges because of the particular geometry of the fractures and the tenuous vascular pattern of the scaphoid. Delays in diagnosis and inadequate treatment for acute scaphoid fractures can lead to nonunions and subsequent degenerative wrist arthritis. Improvements in diagnosis, surgical treatment, and implant materials have encouraged a trend toward early internal fixation, even for nondisplaced scaphoid fractures that could potentially be treated nonoperatively. Despite the advent of newly developed fixation techniques, including open and percutaneous fixation, the nonunion rate for scaphoid fractures remains as high as 10% after surgical treatment. Scaphoid nonunions can present with or without avascular necrosis of the proximal pole and may show a humpback deformity on the radiograph. If left untreated, scaphoid nonunions can progress to carpal collapse and degenerative arthritis. Surgical treatment is directed at correcting the deformity with open reduction and internal fixation with bone grafting. Recently, vascularized bone grafts have gained popularity in the treatment of scaphoid nonunions, particularly in cases with avascular necrosis. This article reviews current concepts regarding the treatment of scaphoid fractures and nonunions.
How does PEMF help with scaphoid fracture?
A total of 53 patients in three different medical centres with a unilateral undisplaced acute scaphoid fracture were randomly assigned to receive either treatment with PEMF (n = 24) or a placebo (n = 29). The clinical and radiological outcomes were assessed at four, six, nine, 12, 24 and 52 weeks. A log-rank analysis showed that neither time to clinical and radiological union nor the functional outcome differed significantly between the groups. The clinical assessment of union indicated that at six weeks tenderness in the anatomic snuffbox (p = 0.03) as well as tenderness on longitudinal compression of the scaphoid (p = 0.008) differed significantly in favour of the placebo group. We conclude that stimulation of bone growth by PEMF has no additional value in the conservative treatment of acute scaphoid fractures.
What is the most difficult hand surgery?
Reconstruction of the flexor tendon injuries is one of the most difficult problems in hand surgery, because the postoperative end-results are often unfavorable. The author discusses the history of the flexor tendon surgery, and then he describes the development of the knowledge regarding the anatomy, the blood supply and the tendon healing of the flexor tendons from the beginning until now. After that he describes the development in suture materials, suture techniques, primary and secondary tendon reconstruction operations, postoperative treatment and rehabilitation programmes. The author describes what kind of progress to be expected in this field in the near future, and then he expresses his viewpoint about the development in the international and national hand surgical societies. He encloses a detailed list of literature for those who are interested in the field.
What is the most common fracture of the carpal bone?
The scaphoid bone is the most commonly fractured of the carpal bones. In the Netherlands 90% of all carpal fractures is a fracture of the scaphoid bone . The scaphoid has an essential role in functionality of the wrist, acting as a pivot. Complications in healing can result in poor functional outcome. The scaphoid fracture is a troublesome fracture and failure of treatment can result in avascular necrosis (up to 40%), non-union (5-21%) and early osteo-arthritis (up to 32%) which may seriously impair wrist function. Impaired consolidation of scaphoid fractures results in longer immobilization and more days lost at work with significant psychosocial and financial consequences. Initially Pulsed Electromagnetic Fields was used in the treatment of tibial pseudoarthrosis and non-union. More recently there is evidence that physical forces can also be used in the treatment of fresh fractures, showing accelerated healing by 30% and 71% reduction in nonunion within 12 weeks after initiation of therapy. Until now no double blind randomized, placebo controlled trial has been conducted to investigate the effect of this treatment on the healing of fresh fractures of the scaphoid. This is a multi center, prospective, double blind, placebo controlled, randomized trial. Study population consists of all patients with unilateral acute scaphoid fracture. Pregnant women, patients having a life supporting implanted electronic device, patients with additional fractures of wrist, carpal or metacarpal bones and pre-existing impairment in wrist function are excluded. The scaphoid fracture is diagnosed by a combination of physical and radiographic examination (CT-scanning). Proven scaphoid fractures are treated with cast immobilization and a small Pulsed Electromagnetic Fields bone growth stimulating device placed on the cast. Half of the devices will be disabled at random in the factory. Study parameters are clinical consolidation, radiological consolidation evaluated by CT-scanning, functional status of the wrist, including assessment by means of the patient rated wrist evaluation (PRWE) questionnaire and quality of life using SF-36 health survey questionnaire. Primary endpoint is number of scaphoid unions at six weeks, secondary endpoints are time interval to clinical and radiological consolidation, number of non-unions, functional status at 52 weeks and non-adherence to the treatment protocol. Trial registration Netherlands Trial Register (NTR): NTR2064
What is the treatment for delayed union of the scaphoid?
The standard treatment for delayed union or nonunion of the scaphoid is operative management. Electrical stimulation has been employed in these clinical situations in patients unable or unwilling to undergo surgical intervention. Recent interest has also focused on the use of low-intensity ultrasound as an adjunct to healing in distal radius and tibial fractures. Results with the use of ultrasound for scaphoid fractures is encouraging. A review of the mechanisms of action, clinical results, and possible indications is presented for these two nonoperative modalities.
Can a scaphoid fracture occur in combat sports?
Scaphoid fractures and nonunions occur commonly in young and adult patients but, generally in the athlete, and even more in combat sports, should be treated promptly and appropriately to avoid undesired late complications .
Abstract
To test the ability of ultrasound to diagnose clinically suspected occult scaphoid fractures.
Keywords
The scaphoid remains the most frequently fractured carpal bone, representing approximately 79% of all fractures of these bones.
Materials and methods
Eighteen patients with an average age of 35 years (range, 10–77 years) who presented with a clinically suspected fracture were included in this prospective study.
Results
Patient data are summarized in Table 1. Ultrasound identified correctly 7 of the 9 x-ray—positive scaphoid fractures (Fig. 1). On US the fractured scaphoid was distinguished from the normal scaphoid (Fig. 2) and from the asymptomatic side (Fig. 3).
Discussion
A definitive test for early detection of clinically suspected scaphoid fractures is needed. Relying on clinical examination alone is unreliable and repeat radiographs may not give positive results for weeks.
What is the scaphoid fracture?
Scaphoid Fracture. The scaphoid is one of eight small bones that make up the “carpal bones” of the wrist. It connects two rows of these bones - the proximal row (closer to the forearm) and the distal row (closer to the hand). This connection puts it at extra risk for injury (Figure 1). The two rows of wrist bones, shown here, ...
How long does it take for a scaphoid fracture to heal?
Although the fracture may heal in as little as six weeks, it may take longer for some patients.
What is the goal of a fracture pattern?
Fracture pattern. The goals of treatment are to relieve pain, maximize function and prevent arthritis. Usually, surgery is needed to clean out the fracture site, to potentially place some form of bone graft to help bone healing, and to stabilize the fracture with pins or screws.
What is a non union fracture?
Scaphoid Non-Union Fractures. A scaphoid non-union fracture refers to a wrist fracture that is failing to heal. A fracture that is healing more slowly than expected is a “delayed union” fracture. If the scaphoid fracture is not healing, you may or may not continue to have symptoms.
What is the pain of a broken wrist?
Most people with a scaphoid fracture (which is the same as a broken wrist) will have pain and/or swelling along the thumb side of the wrist within days following a fall. Because there is no visible deformity and no difficulty with motion, many people with this injury assume that it is a wrist sprain.
Can a scaphoid fracture be seen on x-ray?
A scaphoid fracture is usually diagnosed by an x-ray of the wrist. However, x-rays do not always show scaphoid fractures.
How does ultrasound help with pain?
Ultrasound is a common physical therapy treatment that is thought to speed healing by providing heat to injured tissues. This heat helps to decrease pain, improve cellular healing, and improve how stretchy your injured body part is to help increase range of motion and flexibility.
Why should ultrasound not be used?
When Ultrasound Should Not Be Used. Cancer: Since ultrasound may increase cellular activity, it should not be used over cancerous areas of the body as this is thought to increase chances of metastasis. In children: Ultrasound over the bone that has not fully developed may cause fractures or other problems with the part of the bones ...
Can a physical therapist use ultrasound?
This list of situations where ultrasound should not be used should not be considered complete or absolute. If your physical therapist decides to use ultrasound in the treatment of your condition, be sure to discuss with him or her any concerns that you may have.
Can ultrasound heat up joints?
Over body parts with total joint replacements: Many total joint replacements use special cement to hold the new joint in place, and ultrasound may rapidly heat this cement and damage surrounding body parts.
Can ultrasound be used on reproductive organs?
Over reproductive organs: The effect of ultrasound used over reproductive organs like the testes or ovaries is not fully explored and therefore should be avoided. In areas with decreased temperature sensation: If your injury prevents you from feeling normal hot and cold temperatures, ultrasound should not be used since you would not be able ...
Can ultrasound damage the retina?
Near the eyes: Damage to the retina or lens may result if ultrasound is used near the eyes. Areas around the heart: It is suggested that ultrasound may alter the electrical signals around your heart. If you have a pacemaker, ultrasound may interfere with its normal function.
Can ultrasounds cause fractures?
In children: Ultrasound over the bone that has not fully developed may cause fractures or other problems with the part of the bones that are responsible for growth. During pregnancy: The effect of therapeutic ultrasound on a developing human fetus has not been fully explored and therefore should be avoided during pregnancy. 1 . ...